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Wisconsin rates for HCPCS 0117U

Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, kynurenic acid), LC-MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain

Facilitymedian $1,698 · 10th–90th $676–$3,9810%10%20%10th90th$1,698Professionalmedian $832 · 10th–90th $589–$2,2910%10%20%10th90th$832$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,290.87 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $676.08 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $851.14 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,691.53 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,445.44 / $2,630.27
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $2,884.03 / $4,897.79
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $794.33 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $501.19 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $2,344.23
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $1,000.00 / $2,398.83
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $851.14 / $1,698.24
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,949.84 / $2,754.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $3,981.07
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,778.28
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $4,570.88 / $6,456.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $676.08 / $1,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $501.19 / $1,479.11